Portal venous varix
Updates to Article Attributes
Aneurysms of the portal vein is extremely rare and represent only 3% of all aneurysms of the venous system 1.
Clinical presentation
Most patients are asymptomatic, but may present with nonspecific abdominal pain as a major symptom 2-4.
Pathology
Both congenital and acquired causes have been proposed. Acquired causes may include 2-3:
- portal hypertension: could be contributory but is not essential to the development of portal venous system aneurysms and majority of patients do not have portal hypertension or chronic liver disease.
- necrotizing pancreatitis
- abdominal trauma or surgery
- liver cirrhosis
Location
The most common locations for aneurysms of the portal venous system are 2-3:
- splenomesenteric venous confluence
- main portal vein
- intrahepatic portal vein branches at bifurcation sites
And the rarest locations are splenic, mesenteric, and umbilical veins.
Radiographic features
Diagnosis can be made when the portal vein exceeds 20mm in diameter.
Ultrasonography
Color Doppler ultrasound is the most helpful diagnostic tool. Further work-up may not be necessary 4. Appearing on ultrasound as anechoic masses showing direct luminal continuity with the portal venous system and displayed spectral findings characteristic of portal venous system on colour Doppler ultrasound 5-6.
CT
Dynamic helical CT demonstrated simultaneous enhancement with the portal system 5-6.
MRI
On MR images aneurysms were hypointense owing to flow void on T1-weighted 5.
Complications
Complications include 2-4:
- thrombosis and distal embolism
- portal hypertension
- rupture
- compression of the duodenum
- compression of the common bile duct causing jaundice, cholestasis, and cholelithiasis
- +<li>liver cirrhosis</li>
-</ul><p>And the rarest locations are splenic, mesenteric, and umbilical veins.</p><h4>Radiographic features</h4><h5>Ultrasonography</h5><p>Color Doppler ultrasound is the most helpful diagnostic tool. Further work-up may not be necessary <sup>4</sup>. Appearing on ultrasound as anechoic masses showing direct luminal continuity with the portal venous system and displayed spectral findings characteristic of portal venous system on colour Doppler ultrasound <sup>5-6</sup>.</p><h5>CT</h5><p>Dynamic helical CT demonstrated simultaneous enhancement with the portal system <sup>5-6</sup>.</p><h5>MRI</h5><p>On MR images aneurysms were hypointense owing to flow void on T1-weighted <sup>5</sup>.</p><h4>Complications</h4><p>Complications include<sup> 2-4</sup>:</p><ul>- +</ul><p>And the rarest locations are splenic, mesenteric, and umbilical veins.</p><h4>Radiographic features</h4><p>Diagnosis can be made when the portal vein exceeds 20mm in diameter.</p><h5>Ultrasonography</h5><p>Color Doppler ultrasound is the most helpful diagnostic tool. Further work-up may not be necessary <sup>4</sup>. Appearing on ultrasound as anechoic masses showing direct luminal continuity with the portal venous system and displayed spectral findings characteristic of portal venous system on colour Doppler ultrasound <sup>5-6</sup>. </p><h5>CT</h5><p>Dynamic helical CT demonstrated simultaneous enhancement with the portal system <sup>5-6</sup>.</p><h5>MRI</h5><p>On MR images aneurysms were hypointense owing to flow void on T1-weighted <sup>5</sup>.</p><h4>Complications</h4><p>Complications include<sup> 2-4</sup>:</p><ul>
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